Went in for a First-time colonoscopy then got billed $3000

I recently underwent my first colonoscopy after receiving my new insurance plan from work this year. Being over 45, I knew it was time for this important screening. During the procedure, the doctor found and removed a polyp.

According to the American Cancer Society (ACS) website, a colonoscopy should still be considered preventive care even if a polyp is found and removed (source). However, my experience has been frustrating and confusing.

Initially, the clinic billed my colonoscopy as a diagnostic because they had to remove a polyp. I called both the clinic and my insurance provider (Regence, part of Blue Cross Blue Shield) to dispute this. The clinic insisted they billed it correctly, and the insurance company claimed they couldn't help since the clinic labeled it as diagnostic.

After further discussion, the clinic claimed it was illegal to change the billing code and that they had done everything correctly. Frustrated, I asked the insurance agent to call the clinic to reassess my case.

Today, I received a callback, and now the clinic is saying the procedure was marked as diagnostic because I mentioned having blood in my stool and diarrhea symptoms before the colonoscopy. This contradicts their earlier statement that it was due to the polyp removal.

I understand from other posts that even mentioning symptoms can result in the procedure being labeled diagnostic. However, the conflicting explanations from the clinic have left me feeling misled.

I initially went to get a routine and first-time colonoscopy, not because of the symptoms I’ve been having on and off throughout the years. I thought nothing of mentioning these symptoms to my doctor. I did not realize that simply mentioning my symptoms could change the entire procedure from preventive to diagnostic, especially since I went in just for a routine colonoscopy.